The present invention relates generally to a method of disinfecting medical materials and more particularly to a method and apparatus for disinfecting medical materials by exposing the materials to radio-frequency waves and ionizing radiation. The term medical materials encompasses medical waste, veterinary waste, and medical products.
The problems with current medical waste handling methods, like the problems of solid waste disposal in general, are becoming increasingly acute. Solid waste is primarily disposed of by burning or by burial in landfill. Both of the methods have severe disadvantages. Burning of solid waste liberates waste particles and fumes which contribute to acid rain and other pollution of the atmosphere. Burying the waste results in possible leaks of toxic chemicals into the surrounding earth and contamination of ground water supplies. Although increasing amounts of solid waste are being recycled, which alleviates the problems of incineration and burial, presently available recycling methods do not provide a complete solution to the disposal problem.
Waste disposal is of even more urgent concern when the waste comprises possibly infectious medical waste. Such infectious medical waste is a by-product of veterinary and medical care. For example, regulated medical waste consists of: (1) cultures and stocks of infectious agents and associated biological materials; (2) pathological wastes; (3) human blood and blood products; (4) contaminated sharps, including needles, syringes, blades, scalpels, and broken glass; (5) animal waste; (6) isolation waste, including gloves and other disposable products used in the care of patients with serious infections; and (7) unused sharps. These wastes can generally be divided between (a) general medical waste, including cultures and stocks of infectious agents, associated biologicals, pathological waste, and human blood and blood products; (b) veterinary waste, including animal waste; and (c) waste that is predominately plastic, such as the contaminated and unused sharps and isolation waste. The predominately plastic waste also includes metal as well. Hospitals typically segregate waste by types. Contaminated sharps and isolation waste, however, are of special concern as they may carry highly dangerous pathogens such as AIDS virus or hepatitis virus. Sharps in particular have caused widespread public concern when observed washed up on beaches or in public areas.
Hospitals and other generators of medical and veterinary waste employ three methods of waste handling: (a) on-site incineration of the waste, (b) on-site steam autoclaving of the waste followed by later shipment to a landfill for burying, and (c) collection of the waste by a licensed waste hauler with no on-site processing.
Many hospital incinerators, even those located predominately in urban areas, emit pollutants at a relatively high rate. The Environmental Protection Agency has identified harmful substances in the emissions of such hospital incinerators. They include metals such as arsenic, cadmium and lead, organic compounds, such as ethylene, dioxins and furans, acid gases and carbon monoxide as well as soot, viruses and pathogens. Emissions from these incinerators may be a more significant public health hazard than improper dumping [Steven K. Hall, "Infectious Waste Management: A Multifaceted Problem," Pollution Engineering, 74-78 (Aug. 1989)].
Although steam autoclaving may be used to sterilize waste before further processing, it is expensive and time consuming. Heat denatures the proteins and microorganisms causing protein inactivation and cell death in a short time. Temperature monitoring devices such as thermocouples, and biological indicators, such as heat resistant Bacillus stearothermophilus spores, may be used to assure effective sterilization.
U.S. Pat. No. 2,731,208 to Dodd teaches a steam sterilizing apparatus for disposing of contaminated waste which incorporates shredding the waste ("including paper containers such as used sputum cups," col. 1 lines 287-29). Dodd teaches blowing steam into a container full of waste and processing only limited types of items. The Dodd system has the disadvantage of depositing the shredded final mixture into a sewer, which would cause further environmental problems.
Whether or not the hospital first autoclaves its medical wastes, including broken needles and glass, the waste is then turned over to a licensed waste hauler for transport to a landfill or other depository. U.S. Pat. No. 3,958,936 to Knight discloses compaction of hospital waste for more efficient landfill disposal. Specifically, the reference teaches the application of heat in the range of about 204.degree. C. to 316.degree. C. to hospital and other waste to melt the plastic and convert it into a hard compact block for safer disposal in landfills. The waste is disinfected by the high temperatures, and sharps, such as needles, become embedded in the plastic where they are a reduced mechanical hazard. However, this method suffers from the disadvantage of requiring relatively high temperatures necessitating large energy expenditures and landfill disposal. Metropolitan landfills are becoming filled, and unauthorized dumping is a problem.
A further area of concern is the sterilization of medical products prior to use. By medical product is meant any product which must be sterilized prior to use in health care. This is exemplified but not limited to needles, syringes, sutures, bandages, scalpels, gloves, drapes, and other disposal items. Many reusable items also must be provided in sterile form. Widespread current sterilization methods include the use of autoclaving, ethylene oxide, and ionizing radiation such as gamma radiation. The heat and humidity of autoclaving are quite damaging to many disposable metal products. Ethylene oxide and ionizing radiation are preferred commercially in those cases.
In order to sterilize medical products, poisonous ethylene oxide gas may be used in a closed chamber containing the products to be sterilized. For effective sterilization, not only must the ethylene oxide concentration be controlled carefully, but the temperature, humidity, and porosity of the sterilizer load also must be carefully regulated. Ethylene oxide is relatively slow to dissipate from plastics and its use may require that medical products be stored until the ethylene oxide concentration decreases to a safe level. Ethylene oxide also must be carefully vented to the atmosphere subsequent to the sterilization cycle in order to avoid poisoning operators of the sterilization apparatus.
Ionizing radiation, such as gamma radiation, may be used to sterilize medical products within their packaging; however, it must be administered at such high doses that many plastics become yellow and brittle due to the gamma rays having altered the structure of the polymers of which they are made. For example, U.S. Pat. No. 3,940,325 to Hirao teaches methods for adjusting the formulas of plastics for medical syringes to avoid yellowing and cracking due to exposure to sterilizing gamma radiation. Other substances may also be damaged by exposure to gamma radiation. Such ionizing radiation sterilizes because its high energy photons damage and thereby inactivate the DNA of organisms such as bacteria and viruses. As a result of the inactivation of the DNA, cells lose their ability to reproduce and thereby cause infections. On a large scale industrial basis, ionizing radiation, especially gamma radiation from cobalt 60, has been used to sterilize medical products prior to their use in patients. However, the radiation levels necessary to sterilize may also damage the product being sterilized.
Other methods have been suggested for sterilization of medical products. For instance, U.S. Pat. No. 3,617,178 to Clouston teaches a method of improving sterilization efficiency by increasing hydrostatic pressure. Elevated hydrostatic pressure causes sterilization resistant bacterial spores to germinate, or begin to grow. However, it has no effect on viruses. Bacterial germination, which converts the bacteria from their environmentally resistant spore form, makes the bacteria more sensitive to radiation, so that lower doses may be employed. Clouston further teaches optimizing the hydrostatic pressure effect by adjusting the temperature up to 80.degree. C. According to Clouston, elevated pressure in heated fluid or moist gas is essential to the method. Elevated temperature alone has a negligible effect. Furthermore, the pressure, heat, or moisture treatment taught by Clouston is intended to cause bacterial spores to germinate thereby rendering them more vulnerable to sterilization techniques, not to sterilize or inactivate microorganisms.
In contrast, U.S. Pat. Nos. 4,620,908 to Van Duzer and 3,704,089 to Stehlik teach prefreezing injectable proteins and surgical adhesive prior to irradiation with gamma radiation from cobalt 60 for aseptic manufacture of those materials. U.S. Pat. No. 3,602,712 to Mann discloses an apparatus for gamma irradiation and sterilization of sewage and industrial waste.
Besides gamma radiation, other types of electromagnetic radiation have been considered as potential sterilants in known systems. Microwaves are increasingly being investigated for rapid sterilization of individual medical devices as well as shredded medical waste. Recently, an experiment showed that metallic instruments could be sterilized in only 30 seconds in a microwave oven (New York. Times, "Science Watch Microwave Sterilizer is Developed," Jun. 20, 1989). That particular method, however, suffers from the drawback that only a few such metallic instruments can be treated at a particular time. It is not particularly applicable for treatment of medical waste in bulk, and in particular for treatment of medical waste which has been bagged.
United Kingdom Patent No. 1 406 789 to Boucher discloses a microwave system for the surface sterilization of reusable laboratory, medical, and dental instruments in a moist atmosphere at a lower temperature than those presently used and in a shorter time. The system is intended to render aseptic reusable instruments for medical use and generates electromagnetic energy having frequencies between 100 megahertz and 23000 megahertz. Boucher emphasizes that "his invention deals exclusively with surface sterilization" and that he "does not intend to cover such special cases" as "`in-depth` sterilization" (page 1, lines 58-67). Boucher teaches that only through a combination of proper humidification with the thermal and nonthermal effects of microwave radiation can reproducible and satisfactory results be obtained with a wide variety of species, including thermoresistant spores" (page 1, lines 77-83). Boucher teaches the placement of the object to be sterilized in a gas-tight container with a source of water vapor.
Soviet Union Patent No. 1,123,705 also discloses a method of sterilizing medical instruments for reuse by UHF treatment. For injection needles it discloses a final temperature of 160.degree. C. to 470.degree. C. and for acupuncture needles it discloses a final temperature of 160.degree. C. to 270.degree. C.
Systems are also known for treatment of disposable medical waste utilizing microwaves. This system first shreds the waste, sprays the shredded waste with water, and passes the wet shredded waste through a microwave chamber designed to raise the temperature of the wet shredded waste to 205.degree. C. to disinfect it. After the disinfection step, the system compresses the disinfected shredded waste and packages it for shipment to landfills or incinerators (The Wall Street Journal, p. B-3, Apr. 10, 1989). One potential problem with this system is that shredding before sterilization could release infectious particles to the environment and may thus spread contagion. Another problem is the ultimate disposal of the waste; it persists in landfills or may pollute the air when incinerated.
Also of interest is a method and apparatus for using microwave frequency electromagnetic fields to heat medical waste to disinfect it. "Medical Waste Treatment By Microwave Technology", Norcal Solid Waste Systems. The system includes equipment for receiving the medical waste, shredding it into particle sizes of 1 to 11/2 inch linear dimension, and applying steam to the shredded waste to increase its moisture content, as well as to inactivate certain of the microorganisms thereon. The waste is then carried to a microwave treatment area where microwave energy heats the waste to 203.degree. C. for a selected amount of time. A holding area may provide heat sealing. The waste is then recirculated to the steaming station where steam is again applied to inactivate further microorganisms which may still be active in the waste which is shredded and disinfected, disposed in a dumpster for placement in a landfill. It may be appreciated, however, that volumetric heating cannot take place in such a microwave system that the waste has to be scattered in a relatively thin layer on a conveyor belt for treatment by the microwave radiation as the microwave radiation does not adequately penetrate the material. In addition, the material is not enclosed so that there is no substantial transfer of moisture from wet materials to dry materials to aid in the heating within the enclosed system.
U.S. Pat. No. 3,547,577 to Lovercheck discloses a machine for treating garbage by shredding, compressing the shredded garbage into briquettes, and sterilizing the briquettes with gas. After shredding the garbage is separated into magnetic and nonmagnetic portions. The sterilization step employs ethylene oxide gas which requires temperature control. The briquettes are maintained at a temperature of about 54.degree. C.
Further, microwaves are limited in their penetration and are ineffective for heating when applied to large scale, boxed medical waste of the type which comprises the waste disposal problem today. Microwaves do not heat very effectively because they do not penetrate very deeply. Most of the heat is generated near the surface and quickly dissipates into the surroundings, in part because it is not well conducted into the center portions of the boxed medical waste. In contrast, radio-frequency waves at relatively low frequency can penetrate boxed medical waste more deeply.
It also is known in the art that thermal radiation treatment of bacterial spores and other pathogens may allow greatly reduced ionizing radiation dosage to accomplish sterilization of a given population. For instance, in "Thermoradiation Inactivation Of Naturally Occurring Bacterial Spores In Soil," M. C. Reynolds et al., Applied Microbiology, Vol.28, No. 3, September 1974, it is disclosed that bacterial spores may be inactivated by heating them with dry heat and exposing them to ionizing radiation from a cobalt 60 source allow greatly reduced treatment times over the use of either dry heat or radiation alone.
An attempt to elucidate a model for such behavior is set forth in J. P. Brannen, "A Kinetic Model For The Biological Effects Of Ionizing Radiation", Sandia Laboratories, SAND74-0289(October 1974).
Heat and radiation inactivation of bacteria are discussed at "Progress Report Beneficial Uses Program, Period Ending Dec. 31, 1976", Waste Management and Environmental Programs Department, Sandia Laboratories, SAND77-0426 (1977), where it is taught that viruses in sewage sludge may be destroyed by evaporation. Heat inactivation may be used to destroy Salmonella enterititis ser. montevideo. Streptococcus bacteria may be destroyed by using ionizing radiation at a dose of about 140 kilorads.
The use of cesium 137 to inactivate pathogens in sludge is discussed in "Sludge Or Radiation Disinfection For Beneficial Use", Applied Biology And Isotope Utilization Division 4535, "General Description Of The Sludge And Radiation Process", SAND80-2744 (December 1980), where it is disclosed that cesium-137, emitting gamma radiation may be used to inactivate pathogens in sewage sludge See also, "Use Of Cesium-137 To Process Sludge For Further Reduction Of Pathogens, Sludge Or Radiation Disinfection For Beneficial Use," Disease Control Requirements For Various Sludge Uses, Applied Biology and Isotope Utilization Division 4535, SAND80-2744 (December 1980), which discloses that in order to render sewage sludge safe, in particular for certain agricultural usages, irradiation may be used as an add-on process in conjunction with sterilization where sludge is maintained at 30 min. at a temperature of at least 70.degree. C. In each of the aforementioned papers, it may be appreciated that the sludge which is being treated is substantially homogeneous in its dielectric characteristics and, thus, in its heating characteristics.
The gamma irradiation equipment commonly used and disclosed in this application is of the type disclosed in "Gamma Processing Equipment", AECL Industrial and Radiation Division (January 1987).
The dual plate 12 megahertz plate type radio-frequency heater is of the type disclosed in "Dielectric Heating" PSC Inc which although undated, constitutes prior art to this application.
Like microwaves, radio-frequency waves are a form of electromagnetic energy. They also transfer energy directly into materials, primarily by the interaction of their time-varying electric fields with molecules. Radio-frequency waves may be applied by connecting a radio-frequency alternating current to a pair of electrodes. Between the two electrodes an alternating radio-frequency electromagnetic field having a time-varying electric field component is established. When objects are placed between the electrodes in the time-varying electric field, the time-varying electric field partially or completely penetrates the object and heats it.
Heat is produced when the time-varying electric field accelerates ions and electrons which collide with molecules. Heat also is produced because the time-varying electric field cause molecules, and particularly those with a relatively high electric dipole moment, to rotate back and forth as a result of the torque placed upon them by the time-varying electric field. Most large molecules, or molecules with evenly distributed charge, have relatively low or nonexistent dipole moments and are not very much affected by the radio-frequency time-varying electric field. Small molecules, in particular with polar groups, have relatively large electric dipole moments and thus have relatively large torques exerted upon them by the time-varying electric field. In particular, highly polar molecules, like water, experience relatively large torques and as a result are rotated by the time-varying electric field, thereby transferring mechanical energy to their surroundings as internal energy or heat. Lower frequency time-varying electric fields penetrate deeply and heat objects more evenly. Relatively high frequency time-varying electric fields do not penetrate as deeply, but heat more rapidly the portions of objects they interact with.
It should be noted that a time-varying electric field is always accompanied by a time-varying magnetic field, except where destructive cancellation occurs with interference patterns. For most materials being considered here, the principal heating mechanism arises from the electric fields. These fields can cause both ohmic heating via induced ionic currents and dielectric heating via molecular stressing from the internal electric fields. For very moist materials, the presence of the accompanying time-varying magnetic field can also induce eddy-currents which can also heat the material. Also, some type of combined effect of magnetic fields and heat may occur. While the ensuing discussion is presented in context of an electric field effect, it should be understood that the effects of accompanying time-varying magnetic field are defined here for simplification as part of the electric field phenomena.
Because different materials are composed of different types of molecules with differing electric dipoles, they heat at different rates when exposed to a given time-varying electric field. For example, plastics, which are formed of very large polymer molecules, are not heated by time-varying electric fields as rapidly as water. Metal objects may or may not be easily heated when exposed to time varying electric fields either in the radio-frequency or microwave region. The high conductivity of the metal objects tends to short out the electric fields and rescatter them. As a consequence, there are many conditions where metal objects are difficult to heat, as exemplified by the metal liner of the interior microwave ovens. On the other hand, such time-varying fields can also induce substantial currents which flow on the outside of the metal objects. Under certain circumstances heating effects will occur on the surface of the metal object which, in the case of a small needle, the heat is readily diffused into the interior. In addition, the presence of long, thin metal objects in an electric field causes enhancement of the electric field intensity near the ends of the metal objects and a diminution or shadowing of the fields near the middle. Thus, if the electric field is parallel to the axis of the metal object, strong electric fields will exist near the tips and weak electric fields will exist near the center of the rod or needle. Such field enhancements can lead to arcing and possible fires. In addition, the field suppression or shadowing of such metal objects is also an unwanted feature if the presence of a single electric field vector is-relied upon in its entirety to provide the sterilization. The failure of the radio-frequency electromagnetic field to penetrate the object causing surface heating only, or the opposite failure of the materials to absorb the electric field energy, causes uneven heating of the medical waste. The uneven heating is exacerbated because the medical waste usually comprises mixed materials which are difficult to heat effectively using radio-frequency energy due to the presence of areas of high field absorption, such as are due to metals and concomitant shadowing and cold spots. In addition, similar but less pronounced absorption effects are found with water molecules. Thus, when heterogeneous or mixed medical wastes have wet and dry portions, it may be seen that only the wet portions of such material would be heated. Mixed loads such as hospital wastes were considered impossible to sterilize by radio-frequency energy because the waste contains a wide variety of materials, each having different dielectric properties. A great concern was that the presence of a sufficient number of metallic sharps would lead to arcing, causing ignition of the accompanying dry wastes. Another concern was that even if fire was not started, the differential energy absorption of fluids and sharps would leave dry objects unsterilized.
In fact, other attempts to kill microorganisms with radio-frequency energy have been considered unsuccessful In his 1980 review, "Effects Of Microwave Irradiation On Microorganisms", Advances in Applied Microbiology 26:129-45, Chipley cites an experiment of applying radio-frequency energy to bacteria and viruses which grow on tobacco. The experiment found no effect of the radio-frequency energy on the bacteria and viruses. In another study of radio-frequency energy on contaminated liquid food, there was no showing of "selective killing effect" except when ethanol was added.
In the same review, Chipley cited numerous tests of microwaves on microorganisms and concluded that "results of tests for viability of B. subtilis spores also showed identical death curves compared with those obtained by conventional heat." On the other hand, however, Chipley cites several references which support the view that microwave irradiation has collateral thermal and nonthermal effects. [For example, Culkin and Fung (1975) found that microbial destruction occurred at reduced temperatures and shorter time periods when the material was exposed to microwaves as compared to conventional heating methods. Wayland et al., 1977 also demonstrated the interdependence of heat and microwaves effects in the studies of spores of B. subtilis.
U.S. Pat. No. 2,114,345 to Hayford discloses a radio-frequency applicator with electroscopic control for destroying bacteria in bottled beer and similar products. Hayford teaches an apparatus for sterilizing a series of small objects. The radio-frequency field must be constantly readjusted by the electroscopic control. There is no teaching or suggestion that large scale sterilization of heterogeneous waste could be carried out.
U.S. Pat. No. 3,948,601 to Fraser et al. teaches the indirect use of radio-frequency energy in sterilizing medical and hospital equipment as well as human waste. The reference teaches the use of radio-frequency energy for heating gases, particularly argon, and exciting them so that they ionize into a plasma having a temperature of approximately 100.degree. C. to 500.degree. C. The reference teaches that a cool plasma at a temperature of only 25.degree. C. to 50.degree. C. and very low pressure may effectively sterilize an article. However, sterilization by plasma does not suggest the direct use of radio-frequency waves in sterilization since it is the chemical reactive effect of the plasma which presumably performs the sterilization function rather than the direct or thermal effects of radio-frequency energy on pathogens contained on the material. It may be appreciated that only those portions of the equipment and waste actually contacted by the plasma would be treated.
Reprocessing of the waste, and especially medical waste, is also vital for several reasons. Even if the medical waste has been rendered harmless or innocuous by the destruction of any pathogens associated therewith, there is still the problem of the disposal of the bulk material including the plastics, the sharps, and fibrous material such as gowns, diapers, and the like. The material is relatively bulky and landfills, particularly in many urban areas, have become filled. In addition, older landfills may leak and nonpathogenic but chemically polluting substances may leak into surrounding ground water, causing health hazards. Thus, burying the sterilized medical waste is becoming less attractive. Further, merely burning the sterilized medical waste can pollute the atmosphere and cause acid rain. Current reprocessing technology should be employed to process the sterilized medical waste for effective utilization and proper disposal. What is needed is a method for sterilizing the medical waste and destroying the pathogens thereon and disposing of the sterilized waste in a manner which is harmless to health care workers, waste handlers, and the public at large.
A series of investigations has been undertaken as to sterilization, especially for food. This has resulted in patents or inventions wherein the material to be treated is housed in a microwave transparent container such that the material can be heated at vapor pressures which coexist with temperatures of 120.degree. C. These include Gray U.S. Pat. No. 3,494,723; Nakagawa U.S. Pat. No. 4,808,782; Stenstron U.S. Pat. No. 4,808,783; Landy U.S. Pat. No. 3,215,539; Utosomi U.S. Pat. No. 3,885,915; and Fritz U.S. Pat. No. 4,775,770. All of these patents disclose heating homogeneous material in some form of pouch or pressure container where the material, typically food, is homogeneous. They do not address the special problem considered here where the material is heterogeneous and contains sharps, moist materials and dry materials.